Thyroid

Question 1

Symptoms of hypothyroidism?

Answer 1

thin hair, dry skin, hoarse deep voice, brady, prolonged relaxation of reflexes, and proximal muscle weakness, can cause carpal tunnel.

Question 2

Symptoms of hyperthyroidism?

Answer 2

tachy, fine tremor, exopthalmos (caused by TSI ab), lid lag.

Question 3

Most common cause of hypothyroidism in places with enough iodine?

Answer 3

Autoimmune = Hashimoto’s

Question 4

What’s the weight based calculation for replacing thyroid in patients with hypothyroid?

Answer 4

1.6 mcg/kg/daily, recheck in 6-8 wks and adjust accordingly. In elderly and multiple comorbidities, can start at 25 mcg daily and titrate up.

Question 5

What’s the issue with dessicated thyroid?

Answer 5

there is variability in the thyroid hormone content.

Question 6

What’s the most common reason for failure of treatment of hypothyroid?

Answer 6

compliance and malabsorption, taking with other meds or food. Meds include iron and sucralfate.

Question 7

Risk factors of overtreating hypothyroid?

Answer 7

a-fib, osteoporosis

Question 8

Labs indicative of Graves Disease.

Answer 8

Low TSH, HIGH T4, Negative TPO, POSITIVE TSI (Most specific test)

Question 9

Treatment for Grave’s

Answer 9

Methimazole, PTU is 2nd line due to liver toxicity but is first line in first trimester and after delivery. Propanolol is good for symptoms and also blocks conversion of T4 to T3. Radioablation for those refractory to meds. Graves will often burn out after 6-18 months, can try tapering.

Question 10

Side effects of Methimazole and PTU

Answer 10

Granulocytopenia (present with severe sore throat or fever, check cbc!), aplastic anemia, elevated lft’s, inhibit fetal thyroid gland.

Question 11

Treatment for Exopthalmos of Grave’s?

Answer 11

Glucocorticoids, IV more effective but oral also works.

Question 12

Symptoms of Thyroid storm

Answer 12

HYPERthermia, right upper quadrant pain, diffuse muscle weakness, a-fib, hypomania, confusion, cns signs/symptoms. Lab values do not define thyroid storm, clinical diagnosis.

Question 13

Treatment of thyroid storm

Answer 13

IVF, cooling measures, propanol, methimazole, corticosteroids, then iodine 1 hr later.

Question 14

2 common meds associated with hypothyroid

Answer 14

lithium and phenytoin, amiodarone sometimes

Question 15

2 common meds associated with hyperthyroid

Answer 15

amiodarone and peg interferon alfa-2a

Question 16

Risk factors for thyroid cancer

Answer 16

Nodule > 2cm or rapidly increasing in size, dysphagia, hoarseness, regional adenopathy, fixation to surrounding tissues, female age

Question 17

Thyroid scan, hot vs cold?

Answer 17

Hot or functional- may cause hyperthyroid, usually not malignant, treated wit I131.
Cold or nonfunctional- adenoma or malignancy.

Question 18

Good marker for MONITORING thyroid carcinoma?

Answer 18

Serum thyroglobulin

Question 19

Most common thyroid cancer?

Answer 19

papillary is most common, medullary (elevated calcitonin and associated with MENII)